As the founder of Hip4Kids inc. which has delivered community programming to combat childhood obesity for 12 years I wonder when all those concerned in the fight will take the "chef's perspective" into account. That was the beginning premise, continues to be and is the basis of our cutting edge Project Apple soon to debut in NYC Schools.www.hip4kids.org

Obesity in the western world is different from obesity in countries like India. Here we find a very close relationship between diseases and extra weight. This would be particularly true for men and women in the age group 35-50 with very little physical activity and stressful jobs. For this group, extra weight brings in many problems and additional medical expenses.
Another problem is obese children and this is more prevalent in the middle class families with both parents working and spending money on so called fast food. Here the parents are really not concerned about impact of obesity on the child’s future as the experience is that problems like kidney failures are often associated with fast food intake and obesity.

I often wonder with studies on weight, health and obesity if researchers are oversimplifying their studies and not taking into account important factors like general health, genetics, health history etc. Maybe obesity's affect on health depends on genetics such that some people are healthier with more weight and others less healthy. Adding genetics and overall health assessment to these studies would make them more accurate which is important.

Generally, as they create these experiments, doctors and scientists must take such factors into account when they create the treatment and control groups. They do full health checks to ensure that all those participating are basically the same, without any outstanding health issues that could interfere.

On a no-carb diet, you'll up with the same or higher weight than you are now if you try to do it long-term.

Every person I know that has done that kind of diet couldn't sustain it.

You need carbs, what kind of carbs and how much you consume are what counts.

You also need to give yourself a "fat day" where you can eat whatever you want. It lets you satisfy your temptations in a controlled manner.

The most important thing is what you eat as part of your regular diet.

When you eat the right foods, you don't have to worry about how much you eat because your body will self-regulate - if you eat "too much" at one meal, you won't want to eat as much when it comes time for your next meal.

And one other thing, your body has a minimum weight that it will try to maintain. You can get it down over time, but if you try to crash diet, your body will sense that you're starving and store as much fat as it can.

Good luck with your diet. Don't listen to the nay-sayers. The human body does not need a lot of carbs, and can do quite well on the relatively low level provided by vegetables and fruit. Lowering carb intake compared to current levels is not a crash diet (it was the regular diet for millions of years before agriculture came along). Contrary to the previous reply, low-carb diets typically have better adherence than low-fat diets. And eating more fat won't make you fat.

Take a look at the science...

These two meta-analyses suggest that low-carb diets (some non-energy-restricted) appear to be at least as effective as low-fat diets. (I note, however, that in one of these studies "low carb" was defined as "≤45% of energy from carbohydrates", which is still quite high. Even fewer carbs may have led the low-carb diets to perform even better.)

This is going to be a wall of text but it carries key ideas you should keep in mind. Both JMSZ and ORWELL make some good points although they are structured a bit as antithesis. I think the key thing is how you define diet. You can definitely aquire quite a bit of traction using a low-carb diet, and these are superior in most respects to a low fat diet. However, at the end of the day these diets are most often used as a temporary modification of eating patterns in order to access quick and significant changes in body weight. At least this has always been my experience when I hear people saying they are on a low-carb diet. JMSZ is exactly correct when he says "The most imiportant thing is what you eat as part of your regular diet." To meet fitness goals you have to think in terms of lifestyle, and make adjustment that you can maintain over a life time. Not just "no bread for 3 months, etc." THIS CONCEPT IS THE KEY TO REAL SUCCESS. To do this correctly you have to understand that each food group partitions into many subgroups that have vastly different effects on the body. Carbs come in fiber, simple, and complex. Fiber is good and you don't need to watch intake typically. Complex should be your main source, but not in overabundance. Simple break down into multiple sugar groups. I saw someone reply saying stay away from fructose stuffs because they keep you hungry. This is probably a reply based on an article that recently appeared in the literature. However, fructose is primarily fruit sugar which I would consider to be nominally better than glucose. However, if weight lifting you should consider eating glucose after working out since it requires insulin (which is anabolicaly useful just after working out) in order to process, whereas fructose does not. Fats are probably the most misunderstood, foods high in poly/mono unsaturated fats can typically be eaten in signicant quantities without much worry, they include your Omega's which have been proven to have many health benefits. Even saturated fats are ok in moderation, ie: no more than 30% of fat intake. Stay away from trans fat entirely; no exception. In fact, even if a food item says it has no trans fat, then you need to check the ingredients, if it contains the words hydrogenated or partially-hydrogenated then they are lying to you; it has trans-fat, only the quanitiy is under 0.5g per serving. Protein breaks up into lots of subgroups that are primariy of interest to body builders; caisin, whey, soy, BCAA's (techically not protein but the building blocks of it), with lots of adjectives such as microized, hydrolized, isolate, etc. Meats are of course very high in protein, but this needs to be offset by the amount of saturated fat that accompanies them. Fish and Chicken are all around low fat high protein, Beef is high saturated fat high protein, whereas something like nuts is high poly/mono unsat. fat moderate protein.
I am not writing down the exact dietary changes you need to make, but people need to spend time reading and understanding the basics of food so that they can properly adjust their eating lifestyle; not just blindly adhere to some new weightloss program. Also, eating 6 small meals a day versus 3 large meals is much, much better. I recommend using a meal replacement powder from a nutrition store for one or two of these meals. Although the sticker price may seem steep, calorie-for-calorie they are often a better deal than making food at home and come with very good nutritional profiles built in. Exercise is also important, I personally advocate something around 80% weights to 20% cardio but it depends on your goals and what you enjoy most.
Good luck and hope this was helpful.

When are we going to address a closer reason for obesity: the "hunger" that leads to it. By "hunger" I mean the reason why many overcompensate by overeating. It isn't rocket science, folks. It has to do with the frustration of living incongruously.
M. Teresa Horn, MD

Yes: myself, many people I know, patients of mine (I am a physician)and the huge body of studies done in psychology that point to this. It is widely documented for you to look up. What is missing is linking what is know in different disciplines.

Behind the individual causes, there are societal causes driving the obesity epidemic. (As a public health physician, I'd venture that many clinicians suffer from what has been termed 'individualistic myopia'; the reduced ability to see societal causes behind the individual ones.)

If we look at obesity rates, what changed in the US in the 1980s? Across all ages, the prevalence of obesity started to rise, after having been more or less stable in the decades before.

My guess is that that energy-dense food became cheap, ubiquitous and heavily promoted around that time. Which, combined with a gradually reduced level of physical activity, caused people to consume, on average, just a few kcal more than they spent.

Dear Colleague: I agree with all your points, but you are not including mine, which, I sent out 'a grosso modo' to general public. Now that I am in conversation(writing is silent speech, after all) with a colleague, I can say that public health has not reached the point of being able to take into account the psychology of why people fell for the marketing ploy you so describe so aptly. If people buy, others will manufacture. Where is the regulation to reduce the NEED for cheap, instantly satisfying, 'easy' food: this is the HUNGER I am referring to. Many children, as well as adults, myself sometimes included, who have nothing else to do, eat. I would begin by addressing REAL attention/interaction with children, not the warehousing they are subject to presently. You must admit there is real emotional hunger prevalent everywhere...loneliness, sadness, angst.

Sorry for my late reply. I'd be the last to deny the enormous mental health problems in our societies, and I wholly support your plea for more attention for other people (mindfulness?) and less materialism and greed. The challenge will be to change the environment, cultural as well as material.

My tendency is obviously towards the material side of things (regulation of points of sales - no sugared drinks sold in schools, taxes on fast food, restrictions on advertising), but I do believe that goes well with the broader cultural change that you aim for - if I understand you correctly.

I was hoping our dialogue was not over. With my initial incursion via Sociology, I understand where Public Health comes in. But somewhere down the line, when psychology was woefully not enough, I went looking deeper. Naively, while studying Medicine, I would ask: what is the being of being a doctor, so that knowing this, I would know how to act. Well, I got lots of unacceptable answers, including a lot of Medical Anthropology, so I went to Philsophy. Believe it or not, I found what I was looking for, but nobody wants what I found because it upsets the status quo. The answer was published in 1926, but I'm having a hard time being heard. There is a term I found once that describes a lot of what is going on, although it is no longer in modern dictionaries. ALLOTRION: idle pursuits that distract from serious responsibilities. I believe a great deal of what passes for "medicine" today falls into this category, including the myopic focus on "obesity" without looking very closely into the "why" in each of us. You know that to be thin doesn't necessarily mean "healthy", whatever that is (an overworked, worn-out term if there ever was one). Let's keep this dialogue going, though, as I enjoy hearing from colleagues. PS Finding the being of being a physician (which is not the same as "doctor", by the way) is a synonym to the question "Who am I", the first question asked by all who live everywhere, and remains the first philosophical question of all time, not terribly well answered. I have some bibliography on this if you are interested. Good hearing from you. Hope you are well: a sick physician is a contradiction in terms!

I agree but the wording is needing more explanation. There are more reasons for obesity behind that - prednisone, and menopause with adrenal exhaustion are two. You may laugh at this one but Fluoride used to be used to control Hyperthyroidism but now Industrial Corporations in the US have convinced cities and states in the US to add it to their supplies. It is a by product of the manufacturing process and lifetime exposure is not good. Also what about over crowded inner cities where people have food but not safe places to walk or exercise. ... So complicated a thing... not simple at all...

Of course, logos is everything, and that is precisely where I am stuck. All that you mention is going on and contributing to what I call "incongruence" in our way of living, in our way of being ourselves, obesity being but one incongruence. But patching up piecemeal hasn't--and isn't getting us very far. We need to find our congruence, and what is asked in Case History, to me, is what is fundamental, original to us ALL. No exceptions. The variations in the DETAILS is cultural, but we must move within what is congruent with who we are. I know the "cure" will involve painful re-adjustment, letting go of feudal strongholds of beliefs, of "things have always been done this way"-type of thinking. But we do have our first Case History of ourselves, as a whole, as what we have taken to calling "human".
But we must be willing to go to the very origin of the problems, instead of band-aids on piecemeal topics. This piecemealing is what has kept the promise of "bioethics" from bearing fruit. I long for the first congruence: physicians, as vanguard of the species. If we who do know don't/can't do, what can all others expect, how can they trust...and trust is the first stage of development (Erik Erikson). You must admit we don't/can't trust ourselves, the way we are.

I hope that readers view this new "research" with the same amount of skepticism that others from the political right appeared to hold out on research on the climate. I am afraid they will not, however. Unfortunately, when a scientist says there may be global warming, they are questioned and their research is attacked, with the assumption the research is faulty and probably politically motivated. However, when a scientist claims that their data shows that being a bit obese may lead to a longer life, people basically take that as fact and then simply consider the ramifications; never minding the quality of the research or the possible political motivations.

Hi Idler...People at TE comment all the time on a very important issue: how stories are being covered in the media as we are talking about a story that is being covered by one of the publications in the media, namely, TE. Moreover, this publication and others that are covering this story have also in the past regularly covered "new scientific evidence" as it pertains to other issues such as smoking, natural gas exploration or even climate change, with some valuable lessons learned of how it is viewed, how it is being reported on, and yes, how people agree with or debunk the rearch reported on.

One factor explaining why overweight and obese 1 groups have seemingly lower mortality rates than the general population may be that these groups contain a significant subset of extremely healthly individuals.

The first caveat attached to BMI (as many other commenters have mentioned) is that it overestimates adiposity in athletes and other muscular individuals. Yet I have never seen a study which attempts to figure out what proportion of individuals in the overweight and obese 1 brackets fall into this category.

There are two main points missing in the article. The first is that we now know from empirical evidence that BMI is nearly useless whereas the ratio of height to distance between coccyx and navel is an excellent predictor of chronic diseases because the most dangerous fat storage is around the waist (in both men and women). For reasons that are still not understood, fat storage around the hips is apparently less life-threatening. Secondly, the article ignores entirely quality of life. Obese people suffer a multitude of weight-related injuries to ankles, knees, and hips and are far more likely to suffer from chronic back pain. They take more days off work than normal people. They are less competent at normal life tasks such as going up stairs, getting out of bed, or trying to move quickly over moderate distances. In short, the quality of life for obese people is far poorer than for normal people.

When you add these things up it's pretty clear that a meta-study based on BMI and death-within-period is going to be irrelevant or misleading. Perhaps the next TE article on this topic can be more adequately considered? This is, after all, one of the key issues facing our modern world and TE needs to do a lot more than accept rubbish "science" at face value. As both Nature and Science pointed out a few years ago, over 50% of all published papers are total garbage and a significant number of the remainder are misleading. TE really needs to up its game in regards to coverage of such topics.

CA-Oxonian, you wrote, " TE really needs to up its game in regards to coverage of such topics." You are very correct. Certainly, most mainstream publications could do a much better job of health and scientific-related coverage, but yes, The Economist should be setting itself far above the "mainstream". What was written here was not much different that what I saw on Fox News on the topic (http://www.foxnews.com/health/2013/01/02/being-overweight-may-increase-o...), which is a very scary thought and should strike concern in the minds' of TE's editors.

Perhaps it is the minor negatives that contribute towards activities that are not immediately dangerous. IE, if one is tired/lazy/sore due to their weight, they will not ride bikes in traffic, play in dangerous sports. Brain storming only; knowing more details about the types of deaths would help.

Drug addicts tend to be very, very thin and die very, very young. Can this group be contributing to a negative correlation (which is reported in a limited range) between BMI and lifespan?
They are not very numerous, but the numbers they inject into the statistics are very, very extreme.

The new Flegal meta-analysis summarizes the findings of many studies, but if those studies themselves have flaws, those are reflected in the findings in JAMA.

Potential biases include inadequate removal of the effects of smoking and (undetected) disease both causing a lower weight and a higher risk of death, in combination with a short follow-up period.

There is also no proven mechanism that explains why obesity would reduce mortality, even though it increases the risk of diabetes, cardiovascular disease and much more.

Of course, two thirds of Americans would like to believe that overweight or even obesity is actually good (see e.g. this 'Fierce Fatties' blog entry). That may include JAMA editors and reviewers, and the first author who is well into the overweight range herself. For methodological reasons, the evidences remains questionable.

And here we have a perfect example of weight bias. Dr. Flegal is a highly respected and experienced Senior Scientist with NIH, yet because she's not rail thin, you call into question her work. You do realize that Dr. Flegal is in charge of the NHANES project, right? NHANES is the most respected database of actual, measure health outcomes, and is the data most often cited for national obesity statistics. Her work is renowned, but because you think she's fat, she's clearly just carrying water for her fellow fatties.

What an ignorant an uninformed thing to suggest simply because you're uncomfortable with the results of her work. Give me a break.

Don't be naive. Wishful thinking is highly tempting. Even scientists have their preferred outcomes, and I am probably biased in the other direction, given my own BMI. (And as 'Chief Fatty at Fierce, Freethinking Fatties', your bias is probably the starting point of your thinking on this issue.)

Anyway, in the field, there is certainly no consensus that the favorable association of overweight and class I obesity is causal. It's a highly contested (and methodologically very interesting) field of research.

My own expectation is that, as we get better at assessing diet and physical activity, the relative importance of those will increase, and the emphasis on weight will diminish, as BMI may be largely an indicator of the other two, plus the genes that make some people (much) more prone to gaining weight than others.

At any rate, the solutions are in changing the obesogenic environment. Not in stigmatizing individuals.